20Q: Bilingual Service Delivery: Where Do I Start?

From the Desk of Ann Kummer

Did you know that, unlike most other countries, the United States does not have an official language? It’s true. Although the most commonly spoken language in the United States is English, our country is quite multi-lingual and as such, many of our citizens are bilingual. Spanish is the second most commonly spoken language and one of the fastest growing languages in this country, with over 40.5 million speakers (www.boostlingo.com). However, there are over 350 other languages spoken in the United States, according to the United States Census Bureau. Because we are a multi-lingual country, many children in this country are growing up in bilingual households or they speak one language at home and another language (e.g., English) at school.

Bilingual children can present particular challenges for speech-language pathologists (SLPs). It is important for SLPs to understand typical language development of bilingual children and how to determine when there is a language disorder. It is also important to use effective treatment strategies when working with bilingual children who have language disorders.

Because bilingualism has become more common in this country over the years and this presents such a challenge for SLPs, I’m particularly delighted to introduce Kelly Jackson, and expert on this topic, to you.

Kelly Jackson received her Bachelor of Arts in Communicative Disorders and Spanish and her Master of Science in Speech-Language Pathology from the University of Alabama. She began her career as a speech-language pathologist working in a skilled nursing facility and has experience working in many different settings including hospitals, skilled nursing facilities, and public schools. Kelly has worked with patients ranging from early childhood to geriatric with various speech, language, and swallowing disorders. She speaks Spanish and has had experience in conducting speech therapy and evaluations in Spanish in various settings. She is currently completing an advanced certificate in bilingual speech-language pathology. In her current position, Kelly teaches in the undergraduate and graduate speech-language pathology programs at Samford University in Birmingham, Alabama, and serves as the clinical lab coordinator.

In this course, Kelly Jackson will provide an overview of bilingual service delivery with pediatric clients, including bilingual speech and language development, evaluation, treatment, and the use of interpreters. Speech-language pathologists will learn practical information regarding bilingual service delivery to better serve their diverse caseloads in schools and other clinical practice settings.

Now…read on, learn, and enjoy!

Ann W. Kummer, PhD, CCC-SLP, FASHA, 2017 ASHA Honors
Contributing Editor 

Browse the complete collection of 20Q with Ann Kummer CEU articles at www.speechpathology.com/20Q

20Q: Bilingual Service Delivery: Where Do I Start?

Kelly Jackson

1. What do the terms “bilingual,” “dual language learner,” and “English language learner” mean?

Depending on your practice setting, clients who are exposed to or speak more than one language may be identified using different terms. ASHA defines bilingualism as, “the ability to communicate in more than one language” (ASHA, n.d.) which would make a bilingual person someone who can communicate in more than one language. The term dual language learner can be defined as, “children who have been learning two languages simultaneously from infancy or who are in the process of learning a second language after the first language has developed”. (Paradis, Genesee, Crago, 2011, p.3) The next term, “English language learner” is often used with pediatric clients in the educational system. “English language learners” can be defined as, “language minority students in the United States who are learning English, the majority language, for social integration and educational purposes.” (Paradis, Genesee, Crago, 2011, p. 265). It is important to know that these terms are often interchangeably used to describe children who speak more than one language. There are a few important points about the use of these terms that need to be noted. While they are used interchangeably, they do not necessarily mean the exact same thing. For example, a student can be bilingual and not be an English language learner; they may speak two languages that are not English and may not be learning English. A student may be an English language learner and may be trilingual or multilingual instead of bilingual. A dual language learner may be learning French and Spanish instead of their native language and English. It is important to look further into the language situation of each client beyond what the terms described above can tell you.

2. How does a child develop more than one language?

Bilingual language development is typically classified into two major categories: simultaneous bilingualism or sequential bilingualism.

Simultaneous bilingualism is defined as a child being, “exposed to both languages in their first few months of life.” (Goldstein, 2012, p. 7). Simultaneous bilinguals are generally exposed to both languages in more or less equal amounts. An example would be a family where one parent speaks Spanish exclusively to the child and the other parent speaks exclusively English to the child with the family living in an environment or community that utilizes both languages. The child receives input in both languages consistently early on.

Sequential bilingualism is defined as children who are, “first exposed to one language and then to the second one with significant variation existing in respect to the timing and conditions under which the second language is introduced.” (Goldstein, 2012, p. 7). Sequential bilingual children have developed their first language and then begin learning a second language. An example would be a child from Germany, who speaks only German, whose family moves to the U.S., and he begins to learn English through a program at his English-speaking school.

Generally, research has come to the consensus that the “cut-off” age for differentiating a simultaneous bilingual from a sequential bilingual is three years of age. A child learning a second language prior to three years of age would be considered a simultaneous bilingual and a child learning a second language after three years of age would be considered a sequential bilingual. (Paradis, Genesee, Crago, 2011).

Why does this matter to you as a speech-language pathologist? Whether a child is a simultaneous or sequential bilingual plays a part in what you should expect from the child. A child who is simultaneous bilingual may demonstrate more equal development of both languages where a child who is a sequential bilingual may demonstrate, at least initially, strength in their native language. It is vital to investigate the sequence of language acquisition of bilingual children prior to evaluating their speech or language skills to determine if a speech or language disorder is present.

3. What is the silent or nonverbal period?

Knowledge of characteristics of bilingual language development can aid in determining the presence of a speech or language disorder in children who are bilingual. The silent or nonverbal period can be defined as occurring in the early stages of second language acquisition and is the time when “an individual focuses on listening and comprehension of the new language.” (ASHA, n.d.). During the silent period, children may stop speaking in both languages or speak very little. Children may use gestures to communicate with others during this time. During this time, children are studying the language they are exposed to and typically develop stronger comprehension of the second language. The silent or nonverbal period can continue for a few weeks or a few months depending on the age of the child (Paradis, Genesee, Crago, 2011). It is important to be aware of the potential for a second language learner to have a silent or nonverbal period so as to not confuse this as a language delay or disorder.

4.. What is code-mixing?

Code-mixing is “the use of elements from two languages in the same utterance or in the same stretch of conversation” and includes, “the use of phonological, lexical, morphosyntactic, or pragmatic patterns” (Paradis, Genesee, Crago, 2011, p.88-89). When code-mixing, bilingual children will utilize pieces of both of their languages while speaking. For example, a child may say, “I want to go to la tienda (the store).” They have used English for the majority of the sentence and added the Spanish “la tienda” (the store) to fill in vocabulary they may not have known in English. Code-mixing is considered a typical characteristic of bilingual language development and does not indicate the presence of a speech or language disorder. Much variation exists in the frequency of code-mixing and the specific types of code-mixing that children demonstrate but code-mixing is demonstrated by almost all bilingual children at some point. (Paradis, Genesee, Crago, 2011).

5. What is language attrition?

Language attrition is defined as first language loss gradually over time as children begin to utilize their second language more. (Paradis, Genesee, Crago, 2011). Language attrition occurs for several different reasons including decreased use of the first language in the home secondary to the desire to assimilate into the new environment, fewer educational opportunities in the first language, and age of acquisition of the second language.

6. What are the speech characteristics of bilingual children?

Bilingual children make demonstrate differences in phonological development and production of English phonemes. The production of English phonemes may be influenced by the child’s first language. Children may make errors in English secondary to the lack of an English phoneme in their first language. For example, a child whose first language is Spanish may say “fich” instead of “fish” because the “sh” sound is not present in Spanish. Children may acquire these sounds over time but speech sound errors that are influenced by a child’s first language would not indicate a speech sound disorder. It is important to be knowledgeable of the phonology of a child’s first language when providing evaluations or treatment to determine the presence of a speech sound disorder.

7.  Can you evaluate a bilingual/dual language learner child for a speech or language disorder?

Yes! In my experience, I have frequently seen SLPs and educators wait to evaluate children until after they have been in school and have been learning English for a specific amount of time. Is this best practice? No. A child with a speech or language disorder will present with the disorder in both languages (ASHA, n.d.). When appropriate assessment procedures are used, a bilingual child who is still in the process of learning one or both of their languages can be evaluated. It is common knowledge for SLPs that early intervention in speech or language disorders leads to better outcomes (ASHA, n.d. 2) and this should be applied to all children, including those who are bilingual or dual language learners (ASHA, n.d. 2).

8. Can you evaluate a bilingual child if you do not speak the same language(s) as they do?

Yes! The ASHA document, “Knowledge and Skills Needed by Speech-Language Pathologists and Audiologist to Provide Culturally and Linguistically Appropriate Services” identifies the following as skills needed by a clinician that does not have language proficiency in the language of the client or patient:  knowledge and skill in “obtaining information on the features and developmental characteristics of the language(s)/dialect(s) spoken or signed by the client/patient; obtaining information of sociolinguistic features of the client’s/patient’s significant cultural and linguistic influences; and developing appropriate collaborative relationships with translators/interpreters (professional or from the community)” (ASHA, 2004). More information about interpreters will be provided in a later question.

9. How does the evaluation of bilingual children suspected of speech or language disorders begin?

It is important to begin the evaluation of children suspected of speech or language disorders by looking at the cultural background and language history/background. Information about their exposure to both languages, whether or not they were a simultaneous or sequential bilingual, their current language environment and input, as well their cultural values, beliefs, and practices can help guide you in determining the best methods of evaluation. (Paradis, Genesee, Crago, 2011). Information can be gathered through a thorough interview with the parent or caregiver, as well as with the client depending on their age.

10. In what language should assessments be provided?

A bilingual child with a suspected speech or language disorder should be assessed in both of their languages in order to accurately determine if a disorder is present (Paradis, Genesee, Crago, 2011). As stated earlier, a child with a speech or language disorder will present with a disorder in both of their languages, so it is important to assess them in both of their languages.

11. How do you choose an appropriate assessment?

Choosing an appropriate assessment for an evaluation may be a bit challenging depending on what languages the child speaks. If the child speaks a language that is common in the U.S. such as Spanish, you may have the ability to choose a standardized assessment to use with that child that reflects the unique aspects of bilingual English/Spanish development. However, there are not many assessments that are designed for and standardized with bilingual populations. An important factor when looking at standardized assessments for children from diverse language backgrounds is to examine the normative population the assessment used for standardization. If the normative population is not representative of your client’s language background, then it is not appropriate to use it to gather standardized test scores (ASHA, n.d.). You can, however, still use these assessments informally to gather data regarding your client’s skills in different areas of speech or language. If standardized assessments are not an option for the particular client that you need to evaluate, because they speak an uncommon language or dialect in the U.S., what do you do next? Alternative assessment methods include dynamic assessment and the use of informal assessment measures.

12. What is dynamic assessment?

Dynamic assessment is “a variety of assessment procedures that depart from the traditional procedure of giving a standardized test once as a basis for diagnosis” (Paradis, Genesee, Crago, 2011. P. 222). Through dynamic assessment, the client is administered the assessment, it is scored, and then the client participates in “mediated learning experiences” (Paradis, Genesee, Crago 2011, p.222) where they are taught strategies for participating in the assessment. The thought is that often children score poorly on assessments not due to speech or language impairment but due to cultural or linguistic barriers. Research has shown that children without language impairment improve their scores following mediated learning experiences more than children with language impairment (Paradis, Genesee, Crago, 2011).

13. What informal assessment measures can be used with bilingual clients?

Language sampling can provide clinicians valuable information about a client’s overall language skills without the potential barriers a standardized assessment may have. It is important to examine the best methods of language sampling for a client based on their cultural and linguistic backgrounds. This may include utilizing different communication partners (clinician, peer, adult, etc.) or settings (inside a classroom versus outside on a playground). A clinician utilizing language sampling needs to be familiar with the characteristics of the client’s languages and have the ability, either themselves or through an interpreter, to conduct a thorough analysis of the language sample.

Collecting additional informal assessments of a client’s speech and language abilities may provide valuable information to clinicians. Informal screeners that are created based on specific populations of students within your caseload or that are found in journals may provide a method of determining strengths and weakness of a client. A phonemic inventory can be gathered in their first language and English.

It is important to remember that, as with monolingual clients, no one assessment measure should be used in isolation to determine the presence of a speech or language disorder.

14. Can an English assessment be translated to the language needed to evaluate a client?

The quick answer to this is, no. There are many factors involved in creating and standardizing assessment protocols. Direct translations often do not capture the unique speech and language skills targeted by the assessment appropriately and can continue to lack cultural sensitivity. Additionally, translations of assessments cannot be used to gather standardized data on the client’s performance. For example, a comprehensive expressive and receptive language assessment. A direct translation would look at specific aspects of morphology and syntax that may not even be present in the client’s first language. Things like plural ‘s’ and irregular past tense verbs may not directly translate (Paradis, Genesee, Crago, 2011). Assessments designed for monolingual English-speaking children are exactly that, designed with the language and culture of monolingual children at the forefront. Use of assessments that have been directly translated by a clinician or an interpreter may not truly assess speech and language skills and may inadvertently overidentify bilingual children as exhibiting a speech or language disorder.

15. Once a bilingual child has been identified as exhibiting a speech or language disorder, what language should be used in treatment?

Intervention should be provided in both languages that the child speaks. In general, children who are bilingual are utilizing both languages in some way in the communication environments. Because of this, it is important that we work towards improving their communication skills overall, not just in one language. Research shows that being bilingual or learning two languages does not negatively impact language development or increase language impairment. As noted above, children are likely to use their first language to communicate with others in their community or home environments. Restricting their intervention to one language may cause strain on their emotional well-being. It could prevent them from communicating with their loved ones and within their community. By conducting treatment in both languages, we support their continued interaction with others around them. Shifting from using two languages to using one language can result in the child losing the ability to rely on the other language to help them when they are lacking in one of the languages preventing code-mixing. There are two major approaches to language treatment with children who are bilingual: the bilingual approach and the cross-linguistic approach.

16. What is a bilingual approach to speech and language treatment?

The bilingual approach to intervention focuses on, “constructs common to both languages or errors or error patterns exhibited with relatively equal frequency in both languages” (ASHA, n.d.) In the bilingual approach, the clinician will choose targets that are present in both languages such as overlapping grammar patterns. (Paradis, Genesee, Crago, 2011). In this approach, there is less focus on which language the intervention is provided in and more focus on the shared characteristics that can be targeted.

17. What is the cross-linguistic approach to speech-language treatment with bilingual clients?

The cross-linguistic approach, “focuses on separate training in the phonological, lexical, and grammatical features that are unique to each language.” (Paradis, Genesee, Crago, 2011, p, 224). In this approach, targets that are specific to each language are selected for treatment in that language. This approach addresses the fact that there are differences in the structure of each language. This approach may be used in conjunction with the bilingual approach. (ASHA, n.d.)

18. Can a monolingual SLP provide speech or language treatment to a bilingual client?

Yes, with support. A monolingual SLP can provide services to bilingual clients in both of their languages with the use of a collaborative team. This team may include bilingual paraprofessionals, parents, and peers. Through this approach, a monolingual SLP can train those involved to provide treatment in the appropriate language. It is important to point out that significant training is involved when utilizing paraprofessionals and parents to provide intervention. The SLP must provide specific direct training on the treatment techniques and methods to be used and ensure the understanding of the parent or paraprofessional who is providing the intervention. This may also require the use of an interpreter or translator if the parent does not speak the same language as the SLP.  Research on parent provided intervention in monolingual children has been shown to be effective and it is thought that this is true in the bilingual population. The use of peers for intervention has also been explored in monolingual children and has been found to be effective (Kohnert, et al, 2005).

19. How do you best utilize a translator/interpreter in speech-language evaluation and treatment?

ASHA defines an interpreter as, “a person trained to convey spoken or signed communications from one language to another ” (ASHA, n.d.2) and a translator as, “a person trained to translate written text from one language to another.” (ASHA, n.d.2)         

In the ASHA, 2004 Knowledge and Skills document, they identified knowledge and skills necessary for a monolingual SLP to utilize an interpreter to be the ability to, “maintain appropriate relationships among the clinician, the client/patient, and interpreter/translator; ensure that the interpreter/translator has knowledge and skills in the following areas: native proficiency in the client’s/patient’s language(s)/dialect(s) and the ability to provide accurate interpretations/translations; familiarity with and positive regard for the client’s/patient’s particular culture, and speech community or communicative environment; interview techniques, including ethnographic interviewing; professional ethics and client/patient confidentiality’ professional terminology; basic principles of assessment and/or intervention principles to provide context to understand objectives.” (ASHA, 2004). What does this mean for you as a SLP? You are responsible for making sure that the interpreter that you or your employer provides is appropriately trained to serve as an interpreter. It is important to meet with the interpreter prior to having them work with you and your client in order to ensure they meet all of the characteristics above as well as to provide them with specific information regarding their role in your evaluation or treatment session.

20. Can family members or friends serve as an interpreter for my client?

Often times, a family member who speaks English will accompany the client to an evaluation or treatment session and they may offer to serve as an interpreter for you. There are potential hazards to utilizing a family member or friend as an interpreter. Family members may compromise the reliability of their interpretation secondary to limited training and potential conflict of interest. The age of the family member or friend also may impact their ability to translate and the appropriateness of them serving as an interpreter. For example, a family that brings one of their older children to interpret for them at a meeting to discuss the speech and language evaluation results of one of their younger children. The information discussed in this meeting may be sensitive and may be emotionally distressing for the older child serving as an interpreter. Best practice would be to utilize a professional interpreter in situations where there is an interpreter in the necessary language and to only utilize family members or friends in situations of client preference or when all avenues of finding an appropriate interpreter have been exhausted (ASHA, n.d.2).

References

American Speech-Language-Hearing Association (n.d.) Bilingual Service Delivery. (Practice Portal). Retrieved May 27^th, 2020, from https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935225&section=Overview

American Speech-Language-Hearing Association (n.d.) Collaborating with Interpreters. (Practice Portal). Retrieved May 27^th, 2020, from https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935334&section=Overview

American Speech-Language-Hearing Association (n.d.) Early Intervention. (Practice Portal). Retrieved May 27^th, 2020, from https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589943999&section=Key_Issues

American Speech-Language-Hearing Association. (2004). Knowledge and skills needed by speech-language pathologists and audiologists to provide culturally and linguistically appropriate services [Knowledge and Skills]. Available from www.asha.org/policy. doi:10.1044/policy.KS2004-00215

Guiberson, M (2013). Bilingual Myth-Busters Series Language Confusion in Bilingual Children. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 20(1), 5–14. doi: 10.1044/cds20.1.5

Goldstein, BA (2012). Bilingual language development & disorders in Spanish-English speakers(2nd ed.). Baltimore, MD: Paul H. Brookes Pub.

Kohnert, K, Yim, D, Nett, K, Kan, P F, & Duran, L (2005). Intervention With Linguistically Diverse Preschool Children. Language, Speech, and Hearing Services in Schools, 36(3), 251–263. doi: 10.1044/0161-1461(2005/025)

Paradis, J, Genesee, F, Crago, M  (2011). Dual language development and disorders: a handbook on bilingualism and second language learning(2nd ed.). Baltimore: Paul H. Brookes Publishing.